Subjective outcome related to donor site morbidity after sural nerve graft harvesting: a survey in 41 patients

BMC Surgery

Lars B Dahlin¹  Anette Chemnitz¹  Anders Björkman¹  Alexander Hallgren¹ 

[1] Department of Clinical Sciences Malmö, Hand Surgery, Lund University, Malmö, Sweden

关键词: Pain;    Allodynia;    Cold intolerance;    Nerve injury;    Nerve reconstruction;    Sural nerve;   

Others  :  1123330
DOI  :  10.1186/1471-2482-13-39

 received in 2012-11-09, accepted in 2013-09-16,  发布年份 2013

【 摘 要 】

Background

The sural nerve is the most commonly used nerve for grafting severe nerve defects. Our aim was to evaluate subjective outcome in the lower leg after harvesting the sural nerve for grafting nerve defects.

Methods

Forty-six patients were asked to fill in a questionnaire to describe symptoms from leg or foot, where the sural nerve has been harvested to reconstruct an injured major nerve trunk. The questionnaire, previously used in patients going through a nerve biopsy, consists of questions about loss of sensation, pain, cold intolerance, allodynia and present problems from the foot. The survey also contained questions (visual analogue scales; VAS) about disability from the reconstructed nerve trunk.

Results

Forty-one out of 46 patients replied [35 males/6 females; age at reconstruction 23.0 years (10–72); median (min-max), reconstruction done 12 (1.2-39) years ago]. In most patients [37/41 cases (90%)], the sural nerve graft was used to reconstruct an injured nerve trunk in the upper extremity, mainly the median nerve [19/41 (46%)].

In 38/41 patients, loss of sensation, to a variable extent, in the skin area innervated by the sural nerve was noted. These problems persisted at follow up, but 19/41 noted that this area of sensory deficit had decreased over time. Few patients had pain and less than 1/3 had cold intolerance. Allodynia was present in half of the patients, but the majority of them considered that they had no or only slight problems from their foot. None of the patients in the study required painkillers. Eighty eight per cent would accept an additional sural nerve graft procedure if another nerve reconstruction procedure is necessary in the future.

Conclusions

Harvesting of the sural nerve for reconstruction nerve injuries results in mild residual symptoms similar to those seen after a nerve biopsy; although nerve biopsy patients are less prone to undergo an additional biopsy.

【 授权许可】

   
2013 Hallgren et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]de Moura W, Gilbert A: Surgical anatomy of the sural nerve. J Reconstr Microsurg 1984, 1(1):31-39.
• [2]Dyck PJ, Karnes J, Lais A, Lofgren EP, Stevens JC: Pathologic alterations of the peripheral nervous system of human. In Peripheral neuropathy. 2nd edition. Edited by Dyck PJ, Thomas PK, Lambert EH, Bunge R. Philadelphia: W.B. Saunders; 1984:771-778.
• [3]Sima AA, Bril V, Nathaniel V, McEwen TA, Brown MB, Lattimer SA, Greene DA: Regeneration and repair of myelinated fibers in sural-nerve biopsy specimens from patients with diabetic neuropathy treated with sorbinil. N Engl J Med 1988, 319(9):548-555.
• [4]Dahlin LB, Eriksson KF, Sundkvist G: Persistent postoperative complaints after whole sural nerve biopsies in diabetic and non-diabetic subjects. Diabet Med 1997, 14(5):353-356.
• [5]Miloro M, Stoner JA: Subjective outcomes following sural nerve harvest. J Oral Maxillofac Surg 2005, 63(8):1150-1154.
• [6]Ehretsman RL, Novak CB, Mackinnon SE: Subjective recovery of nerve graft donor site. Ann Plast Surg 1999, 43(6):606-612.
• [7]Lapid O, Ho ES, Goia C, Clarke HM: Evaluation of the sensory deficit after sural nerve harvesting in pediatric patients. Plast Reconstr Surg 2007, 119(2):670-674.
• [8]IJpma FF, Nicolai JP, Meek MF: Sural nerve donor-site morbidity: thirty-four years of follow-up. Ann Plast Surg 2006, 57(4):391-395.
• [9]Martins RS, Barbosa RA, Siqueira MG, Soares MS, Heise CO, Foroni L, Teixeira MJ: Morbidity following sural nerve harvesting: a prospective study. Clin Neurol Neurosurg 2012, 114(8):1149-1152.
• [10]Dahlin LB, Lithner F, Bresater LE, Thomsen NO, Eriksson KF, Sundkvist G: Sequelae following sural nerve biopsy in type 1 diabetic subjects. Acta Neurol Scand 2008, 118(3):193-197.
• [11]Ng SS, Kwan MK, Ahmad TS: Quantitative and qualitative evaluation of sural nerve graft donor site. Med J Malaysia 2006, 61:13-17.
• [12]Aszmann OC, Muse V, Dellon AL: Evidence in support of collateral sprouting after sensory nerve resection. Ann Plast Surg 1996, 37(5):520-525.
• [13]Theriault M, Dort J, Sutherland G, Zochodne DW: A prospective quantitative study of sensory deficits after whole sural nerve biopsies in diabetic and nondiabetic patients. Surgical approach and the role of collateral sprouting. Neurology 1998, 50(2):480-484.
• [14]Chemnitz A, Bjorkman A, Dahlin LB, Rosen B: Functional outcome thirty years after median and ulnar nerve repair in childhood and adolescence. Journal of Bone and Joint Surgery (Am) 2013, 95(4):329-337.